Taxonomy Codes
The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:
| No. |
Taxonomy Code |
Taxonomy Clasification |
Taxonomy Specialization |
License Number |
License State |
Primary |
| 1 | 207LP2900X | Anesthesiology | Pain Medicine | 25MB06328000 | NEW JERSEY | No |
| 2 | 207LP2900X | Anesthesiology | Pain Medicine | OS007641L | PENNSYLVANIA | Yes |
Other Identifiers
The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.
| No. |
Other Provider Identifier |
Other Provider Identifier Type |
Other Provider Identifier State |
Other Provider Identifier Issuer |
| 1 | 767931 | OTHER | PENNSYLVANIA | PA BLUE SHIELD |
| 2 | 0850603 | OTHER | PENNSYLVANIA | AETNA |
| 3 | 1189577 | OTHER | NEW JERSEY | AETNA |
| 4 | 22-1994560 | OTHER | NEW JERSEY | FIRST MCO |
| 5 | 22-1994560 | OTHER | PENNSYLVANIA | PHCS |
| 6 | 23-2919275 | OTHER | PENNSYLVANIA | PROCURA MANAGEMENT |
| 7 | 2558332 | OTHER | PENNSYLVANIA | AETNA |
| 8 | 767931S8T | MEDICARE PIN | PENNSYLVANIA | |
| 9 | 767931GDN | MEDICARE PIN | PENNSYLVANIA | |
| 10 | 0711815000 | OTHER | PENNSYLVANIA | IBC RPODUCTS |
| 11 | 1100766 | OTHER | PENNSYLVANIA | KEYSTONE MERCY |
| 12 | 22-1994560 | OTHER | NEW JERSEY | HORIZON BLUE CROSS BLUE SHIELD |
| 13 | 22-1994560 | OTHER | PENNSYLVANIA | PROCURA MANAGEMENT |
| 14 | 23-2919275 | OTHER | PENNSYLVANIA | DEVON |
| 15 | 767931Q1R | MEDICARE PIN | PENNSYLVANIA | |
| 16 | P00083099 | OTHER | PENNSYLVANIA | RAILROAD MEDICARE |
| 17 | P00778988 | MEDICARE PIN | PENNSYLVANIA | |
| 18 | 050057717 | OTHER | PENNSYLVANIA | RAILROAD MEDICARE (GROUP DB0435) |
| 19 | 767931 | OTHER | PENNSYLVANIA | PERSONAL CHOICE |
| 20 | 1100766 | OTHER | PENNSYLVANIA | HORIZON MERCY |
| 21 | 30012425 | OTHER | PENNSYLVANIA | KEYSTONE MERCY |
| 22 | 0711815000 | OTHER | PENNSYLVANIA | KEYSTONE HEALTH PLAN EAST |
| 23 | 22-1994560 | OTHER | NEW JERSEY | UNITED HEALTHCARE/OXFORD |
| 24 | 23-2919275 | OTHER | NEW JERSEY | HORIZON BLUE CROSS BLUE SHIELD |
| 25 | F79184 | MEDICARE UPIN | PENNSYLVANIA | |
| 26 | 767931 | MEDICARE ID-TYPE UNSPECIFIED | PENNSYLVANIA | |
| 27 | 001467070 | MEDICAID | PENNSYLVANIA | |
| 28 | 22-1994560 | OTHER | PENNSYLVANIA | FIRST MCO |
| 29 | 22-1994560 | OTHER | PENNSYLVANIA | UNITED HEALTHCARE/OXFORD |
| 30 | 23-2919275 | OTHER | PENNSYLVANIA | FIRST MCO |
| 31 | 23-2919275 | OTHER | NEW JERSEY | FIRST MCO |
| 32 | 23-2919275 | OTHER | PENNSYLVANIA | HEALTH AMERICA/HEALTH ASSURANCE |
| 33 | DD1386 | OTHER | PENNSYLVANIA | RAILROAD MEDICARE |
| 34 | 50059321 | OTHER | PENNSYLVANIA | CAPITAL BLUE CROSS |
| 35 | 1208598 | OTHER | NEW JERSEY | AETNA |
| 36 | 20051602 | OTHER | PENNSYLVANIA | AMERIHEALTH MERCY |
| 37 | 22-1994560 | OTHER | PENNSYLVANIA | DEVON |
| 38 | 22-1994560 | OTHER | PENNSYLVANIA | HEALTH AMERICA/HEALTH ASSURANCE |
| 39 | 22-1994560 | OTHER | PENNSYLVANIA | GREAT WEST HEALTHCARE |
| 40 | 23-2919275 | OTHER | NEW JERSEY | UNITED HEALTHCARE/OXFORD |
| 41 | 23-2919275 | OTHER | PENNSYLVANIA | GREAT WEST HEALTHCARE |
| 42 | 073171RVB | MEDICARE PIN | NEW JERSEY | |
| 43 | 9848467 | OTHER | PENNSYLVANIA | CIGNA |
| 44 | 1813313 | OTHER | PENNSYLVANIA | FIRST HEALTH NETWORK |
| 45 | 20051603 | OTHER | PENNSYLVANIA | AMERIHEALTH MERCY |
| 46 | 23-2919275 | OTHER | PENNSYLVANIA | UNITED HEALTHCARE/OXFORD |
